Evaluation of cerebral autoregulation of oxygen by NIRS method during postnatal transition period in term and late preterm newborns without resuscitation requirement.

BACKGROUND: Pulse oximetry is commonly used to monitor arterial oxygen saturation and heart rate during the transition period and reference intervals have been determined. However, the effect of the change in arterial oxygen saturation on tissue oxygenation does not seem to be the same. So, a non-invasive method for monitoring cerebral or regional tissue oxygenation will be potentially useful for vulnerable infants. This study aims to evaluate the effectiveness of cerebral autoregulation in the first 10 min after delivery in term and late preterm newborns without resuscitation requirement. METHODS: Cerebral tissue oxygen saturation was measured in the first 10 min after birth with near-infrared spectroscopy (NIRS) from the left forehead. Peripheral oxygen saturation was measured with pulse oximetry from the right hand and cerebral fractional tissue oxygen extraction was calculated. RESULTS: Nineteen late preterms and 20 term infants were included in the study. There was no statistically significant difference between median cerebral tissue oxygen saturation and cerebral fractional tissue oxygen extraction values of late preterm and term infants (p < 0.001). There was a strong inverse relationship between cerebral tissue oxygen saturation and cerebral fractional tissue oxygen extraction (p < 0.001). CONCLUSIONS: In late preterm infants similar to term infants, arterial oxygen saturation and cerebral tissue oxygen saturation increased with time, but inverse reduction of cerebral fractional tissue oxygen extraction showed the presence of an active autoregulation in the brain. This can be interpreted as the ability of the brain to protect itself from hypoxia by regulating oxygen uptake during normal fetal-neonatal transition process. A larger scale multi-center randomized control trial is now needed to further inform practice.

Antenatal corticosteroid administration is associated with lower risk of severe ROP in preterm twin infants.

INTRODUCTION: Robust evidence revealed the impact of antenatal corticosteroid (ACS) administration on lower mortality and short-term neonatal outcomes in singleton preterm infants. We aimed to investigate the impact of ACS therapy on morbidity and mortality in preterm twin infants. METHODS: We conducted this retrospective single-center study from to the records of twin babies of 24-30 weeks of gestation admitted to the neonatal intensive care unit. The study population was grouped based on the exposure to ACS 1-7 days before birth as received or not. Groups were compared regarding in-hospital mortality and neonatal outcomes. RESULTS: Data from 160 twin infants were analyzed. Of those, 102 (64 %) were administered ACS. The median (IQR) gestational age and birth weight of the whole cohort were 28 (27-29) weeks and 1060 (900-1240) g, respectively. ACS administration was associated with a significant decline in respiratory distress syndrome (RDS), requirement ≥2 doses of surfactant, severe intraventricular hemorrhage (IVH), early-onset sepsis (EOS), and retinopathy of prematurity (ROP) requiring treatment (p < 0.05). Logistic regression analysis revealed that gestational age (OR 0.29 95 % CI 0.14-0.62; p = 0.001), ACS administration (OR 0.14 95 % CI 0.03-0.85; p = 0.032), and time to achieve full enteral feeding (OR 1.16 95 % CI 1.03-1.31; p = 0.019) were independently associated with the risk of severe ROP. CONCLUSION: The reduction in the risk of severe ROP besides RDS, severe IVH, and EOS among preterm twins who received ACS was remarkable in our study similar to the trials conducted in preterm singletons. However, large-scale prospective observational studies are required to reveal the efficacy of ACS in preterm twins.

Comparison of Bilevel Volume Guarantee and Pressure-Regulated Volume Control Modes in Preterm Infants.

The present study aimed to compare the bilevel volume guarantee (VG) and pressure-regulated volume control (PRVC) modes of the GE® Carescape R860 model ventilator and test the safety and feasibility of these two modes in preterm neonates. Infants who were less than 30 weeks of gestational age were included. After randomization, initial ventilator settings were adjusted for each patient. After the first 2 h of ventilation, the patients were switched to the other ventilator mode for 2 h. The ventilator parameters, vital signs, and blood gas values were evaluated. The study included a total of 28 patients, 14 in the PRVC group and 14 in the bilevel VG group. The mean birth weight was 876 g (range: 530-1170) and the mean gestational age was 26.4 weeks (range: 24-29). The patients' peak inspiratory pressure (PIP2 and PIP3) was lower after ventilation in bilevel VG mode than in PRVC mode (13 vs. 14 cmH2O, respectively; paired samples t-test, p = 0.008). After 2 h of bilevel VG ventilation, the mean heart rate decreased from 149/min to 140/min (p = 0.001) and the oxygen saturation increased from 91% to 94% (p = 0.01). Both the PRVC and bilevel VG modes of GE ventilators can be used safely in preterm infants, and bilevel VG mode was associated with more favorable early clinical findings. Studies including more patients and comparing with other modes will clarify and provide further evidence on this subject.

Effect of phototherapy on the ductus arteriosus diameter in extremely premature infants: A randomised controlled trial.

Patent ductus arteriosus (PDA) is a common complication among preterm infants (especially birth weight < 1000 g) and is closely associated with mortality and morbidity. Phototherapy (PT) is frequently used in the treatment of jaundice in premature infants in the first week of life. The relationship between PT and PDA has been investigated in a small number of studies but has not been fully elucidated because the studies had varying results. AIM: To examine the effect of PT on parameter (DA diameter, left atrial/aortic root ratio) in premature infants. METHODS: The study was planned as a prospective, randomised, double-blind study. A total of 83 infants <1000 g and < 30 weeks of gestation were included, and they were divided into two groups: the non-shielded and shielded groups. The babies included in the study were evaluated with a Doppler echocardiogram before and after PT. RESULTS: The hemodynamically significant PDA (hs-PDA) and left atrial/aortic root ratio significantly decreased in the shielded group, and the need for treatment due to PDA was significantly lower. The PT times of both groups were similar. CONCLUSION: Shielding application decreases the rate and severity of hs-PDA in extremely premature babies receiving PT.

Comparison of different growth curves in the assessment of extrauterine growth restriction in very low birth weight preterm infants.

BACKGROUND: Preterm infants are at risk of extrauterine growth restriction (EUGR) and associated complications in the long term. Growth curves are important in assessing postnatal growth in these infants. The aim of this study was to determine the prevalence of EUGR in preterm infants and the factors associated with EUGR using two different growth curves. METHODS: We retrospectively evaluated 596 preterm infants with birth weight ≤1500 g. Small for gestational age (SGA) was defined as birth weight <10th percentile for gestational age. EUGR was defined as discharge weight z score <-2. All z scores were determined using both the Fenton 2013 and Intergrowth-21st (IG-21) growth curves. RESULTS: The infants' median gestational age was 28 weeks (27-29) and median birth weight was 1080 g (900-1243). The prevalence of SGA was 9.2% with IG-21 curves and 5% with Fenton curves (p < 0.001). The median discharge weight was 2060 g (1860-2363). The prevalence of EUGR was significantly higher with the Fenton curves than with the IG-21 curves (38% vs. 31.7%, p < 0.001). The mean discharge weight z score was -1.82±1.29 with Fenton and -1.44±1.49 with IG-21 curves. In multivariate analysis, significant risk factors for EUGR according to the Fenton curves were SGA (odds ratio [OR]: 19.15, 95% confidence interval [CI]: 4.4-82.59), respiratory distress syndrome (RDS) (OR 1.64, 95% CI 1.12-2.4), late neonatal sepsis (LNS) (OR: 2.27, 95% CI: 1.5-3.44), and >16 days to full enteral feeding (OR: 1.8, 95% CI: 1.22-2.68). Similarly, independent risk factors for EUGR according to the IG-21 curve were SGA (OR: 16.3, 95% CI: 7.23-36.9), RDS (OR: 1.81, 95% CI: 1.16-2.83), LNS (OR: 2.29, 95% CI: 1.43-3.68), and >16 days to full enteral feeding (OR: 2.11, 95% CI: 1.38-3.23). CONCLUSION: The growth curves used for diagnosis may lead to differences in EUGR rates in intensive care units and the factors identified as associated with EUGR. At-risk infants should be evaluated for EUGR and their weight and nutritional support should be monitored carefully. Comparisons of long-term outcomes are needed to assess the suitability of growth curves used for EUGR follow-up.

Effect of Therapeutic Hypothermia Treatment on Acute Phase Reactants.

OBJECTIVE: In our study, we aimed to examine the effect of therapeutic hypothermia treatment on C-reactive protein (CRP) and interleukin-6 (IL-6) in infants with hypoxic ischemic encephalopathy (HIE). METHODS: The data of the patients with the diagnosis of HIE we followed up in our unit between 2017 and 2018 were analyzed retrospectively. Patients who died during follow-up and patients with proven septicemia at the time of examination were excluded from the study. The routine CRP and IL-6 values ​​of the patients included in the study were compared before and after hypothermia treatment. RESULTS: Therapeutic hypothermia treatment applied for 72 hours was found to cause a statistically significant increase in CRP after treatment when compared with the values ​​measured before treatment (0.6 (0.2-1.9) before and median (P25-75), and after treatment 7.5 (4-18) and median (P25-75) mg/L, p=0.00). While IL-6 was found to be high in the early period due to the effect of hypoxia, it was found to be low after hypothermia treatment (80.5 (40-200) median (P25-75) - 32 (18-50) median (P25-75) pg/ml, p=0.131). While the white blood cell count was high before hypothermia treatment due to hypoxia, it was found to be low after treatment (24600 (19600-30100) median (P25-75) -11300 (8800-14200) median (P25-75)/µL, p=0.001). CONCLUSION: White blood cells and IL-6 can be found to be high due to hypoxia without infection, and CRP can be found to be high after therapeutic hypothermia treatment without infection. The effect of hypoxia and hypothermia should be considered when evaluating acute phase reactants.

Platelet mass index in very preterm infants: can it be used as a parameter for neonatal morbidities?

OBJECTIVE: Platelet mass index (PMI) is related to the platelet functionality. The aim of this study was to evaluate the correlation between PMI and the occurrence of various inflammation-related morbidities of prematurity, such as bronchopulmonary dysplasia (BPD), necrotizing enterocolitis (NEC), retinopathy of prematurity (ROP), intraventricular hemorrhage (IVH) and sepsis in very low-birth weight (VLBW) infants. METHODS: This retrospective analysis of VLBW infants admitted to a level 3 neonatal intensive care unit from October 2012 and 2014, n = 330. Platelet mass was calculated and recorded on the day of birth and between 3 and 7 days (second measure) for each patient. Statistical analysis included analysis of paired samples t test and independent samples t test. RESULT: Among VLBW neonates, PMI values were lower in infants with ROP (p = 0.016), BPD (p = 0.002), IVH (p = 0.018) and NEC (p = 0.011) when compared with the control group in the second measurement. CONCLUSIONS: In this study, we found that premature infants with BPD, NEC, ROP, IVH and sepsis had lower PMI levels in early postnatal life than infants without these diseases. This might be associated with the inflammatory process.